Winter Vertigo: BPPV or Vestibular Neuritis

When people say vertigo, they often mean a spinning sensation that arrives without warning and makes the room feel in motion. In the colder months we see two patterns again and again. One is brief and positional, flaring when you roll over in bed or tip your head to look up. The other is sudden and sustained, with hours or days of spinning that eases very slowly and can leave you unsteady for a time. The first fits benign paroxysmal positional vertigo, usually shortened to BPPV. The second fits vestibular neuritis. Winter favours upper-respiratory infections, so it is no surprise that inflammation of the balance nerve is a regular guest. At the same time, seasonal routines change how we move and sleep, which can make positional vertigo more likely to show itself.

What these conditions are in simple terms

BPPV happens when tiny crystals that normally sit quietly in the inner ear’s balance chambers become dislodged and drift into a semicircular canal. Head movement shifts the crystals and produces a short burst of incorrect movement signals. The brain reads that as spinning even though the eyes and muscles say the room is still. The spell settles when the crystals stop moving, only to return with the next specific movement. Vestibular neuritis is different. The balance nerve that carries motion signals from the inner ear becomes inflamed, most often after a viral illness. The affected ear then sends weaker signals while the healthy ear continues as normal. The mismatch is constant at first, so the spinning lasts far longer and nausea is common. Because the hearing part of the inner ear is separate, hearing usually remains normal with vestibular neuritis. If true hearing loss arrives at the same time, clinicians think about labyrinthitis instead and the plan changes.

How BPPV tends to feel in daily life

People with BPPV often describe clean, repeatable triggers. Turning in bed to the same side brings on a short spin. Sitting up from lying flat is another trigger. Looking up to reach a high shelf, or bending to tie shoes, can do it too. The spinning usually lasts seconds to a minute, then fades completely. Between attacks you may feel normal or slightly off balance for a short while. Nausea can appear during the spin but quickly subsides once still. Headache is not a core feature, hearing is unchanged and there is no ear pain. The pattern can cluster, disappearing for weeks then returning. It is common to worry that something serious is being missed, yet this repeatable, position-linked pattern is highly characteristic and responds well to the right manoeuvres.

How vestibular neuritis tends to feel in daily life

Vestibular neuritis typically begins abruptly over hours, sometimes following a bad cold or flu. The spinning is present at rest, worsens with movement and often brings vomiting in the first day. Standing and walking feel difficult and the world may jerk slightly with head turns because the stabilising reflex between inner ear and eyes is temporarily out of tune. Hearing remains normal, and there is usually no ear pain. After the first intense phase, the brain begins to adapt. Many people notice a steady improvement across days, although a background unsteadiness and sensitivity to busy visual scenes can linger for a couple of weeks. A small subset feel off balance for longer, which is where targeted rehabilitation helps. The key difference from BPPV is duration. This is not a few seconds when rolling in bed; it is a continuous problem that settles only gradually.

If your pattern sounds like classic BPPV, keeping calm and moving with care are the first priorities. The inner ear adapts better when you remain gently active rather than stay in bed. Some people improve simply by continuing daily life and sleeping with an extra pillow for a few nights. If spells are troublesome, a canalith repositioning manoeuvre such as the Epley can guide the loose crystals back where they belong. This is a sequence of head and body positions performed in clinic or taught carefully for home. When carried out for the correct canal, it often brings rapid relief. Because diagnosis drives the choice of manoeuvre, a brief assessment is worth it before you try to treat yourself from a video that may not fit your pattern.

If your picture fits vestibular neuritis, comfort and gradual recalibration are the goals. In the first forty-eight to seventy-two hours, short courses of anti-sickness medication and vestibular suppressants can reduce vomiting and allow rest. They are not a long-term fix, and using them for more than a few days can slow normal recovery. As the acute phase passes, simple vestibular rehabilitation exercises and a return to gentle activity speed adjustment. Most people do not need complex programmes. Short, frequent walks, looking at stable targets while turning the head slightly and increasing movement little by little are often enough. Sleep, hydration and steady routines make a visible difference.

When to seek urgent assessment and what clinicians look for

There are clear red flags that call for prompt medical review. Sudden severe headache unlike usual patterns, weakness or numbness in the face, arm or leg, slurred speech, double vision, difficulty swallowing or a drooping face demand emergency care because they can signal a stroke. A new hearing loss with vertigo is not typical of vestibular neuritis and needs urgent assessment. Fever with ear pain and discharge points away from the inner ear and towards infection in the canal or middle ear, which has a different pathway. If vertigo persists continuously for days without any improvement, or if you cannot keep fluids down, you should also be seen.

In clinic, the story does most of the work. For BPPV, clinicians use positional tests that look for brief, direction-specific eye movements that appear and fade in seconds. If the pattern is present, a therapeutic manoeuvre can be done there and then. For vestibular neuritis, examination shows a non-fatigable nystagmus in one direction, a positive head-impulse test and reduced balance responses on the affected side. Hearing checks are normal. Imaging is rarely needed when findings are consistent and there are no red flags. When doubt remains, further testing is arranged to close it.

Treatment paths you can expect

The treatment for BPPV is mechanical rather than medicinal. A correctly performed canalith repositioning manoeuvre often brings immediate or rapid improvement. Some people need a repeat visit and a short period of home exercises. Medication plays only a limited role and is not used long term. Falls prevention advice is sensible in the first few days when spells are active. For vestibular neuritis, the mainstays are short-term symptom control, early mobilisation and vestibular rehabilitation. There is ongoing debate about the role of corticosteroids when started very early. Some studies suggest improved recovery of nerve function if treatment is begun in the first seventy-two hours, while others show limited benefit on real-world symptoms. Decisions are individual and based on timing, severity and other health factors. Antibiotics do not have a role unless there is a specific bacterial infection elsewhere, and prolonged use of vestibular suppressants is discouraged because it delays the brain’s natural compensation.

Why winter context matters and how to stack the odds in your favour

Cold weather drives people indoors and increases viral spread, which is one reason neuritis clusters in winter. It also changes the way we move. More time on sofas and pillows, a slip that knocks the head, or a week sleeping in a different position can be enough to unmask positional symptoms in someone who already has loose crystals. The practical response is not complicated. When you have a heavy cold, be kind to your balance system for a few days. Rise slowly, keep well hydrated, and avoid long car journeys immediately after an acute vertigo day if you can. Make your home just a little safer while symptoms are active by improving lighting at night and keeping stairs and bathrooms free of clutter. If you already live with intermittent BPPV, tell close family what it looks like in you so they are less alarmed if an episode appears.

How Audiocare supports you through the season

Our aim is to turn a frightening sensation into a clear plan. That starts with a calm conversation about exactly how your episodes behave, followed by a focussed examination to confirm the pattern and rule out the exceptions. If BPPV is the culprit, we perform a targeted manoeuvre and teach you how to move safely for the next forty-eight hours while things settle. If the picture fits vestibular neuritis, we help you through the acute phase without over-reliance on sedating medication, then coach simple rehabilitation that you can build into daily life. If anything does not fit, or if hearing changes are present, we explain what else needs to be checked and arrange the right pathway. The point is not simply to label the condition. It is to give you back control so that winter plans remain yours.

Conclusion

Both BPPV and vestibular neuritis are common and unsettling, yet they differ in ways you can feel. BPPV is brief and position-linked, and responds to the right manoeuvre. Vestibular neuritis is sustained after a viral illness, eases gradually and improves fastest with early movement and simple rehabilitation. Neither condition is helped by weeks of sedating tablets. Both are helped by clear assessment, steady routines and confidence that you are choosing the right next step. If your story matches what you have read here, a short appointment can confirm the pattern and get you back on your feet with fewer surprises.